Hospitals, State Probing Caribbean Med School

Three Connecticut hospitals may stop providing hands-on training to students from a Caribbean medical school whose graduates are banned from practicing in six states.

The hospitals came under scrutiny last month when a Courant investigation revealed Spartan Health Sciences University's minimal entrance requirements and bare-bones facilities. Its students are not even allowed to train in hospitals on the school's home island of St. Lucia.

FOR THE RECORD - Correction published July 9, 2004.The name of Dr. J. Robert Galvin, state commissioner of public health, was incorrectly given as Dr. Robert J. Galvin in a story on Page 1 on June 30 and in several previous stories.

State health commissioner Robert J. Galvin also said he is willing to send state regulators to investigate Spartan if no national body can be persuaded to take on the task of inspecting off-shore medical schools.

Galvin said he launched his own probe into links between Spartan and the Connecticut hospitals after reading the Courant report.

St. Mary's Hospital in Waterbury, Griffin Hospital in Derby and St. Raphael's in New Haven all have accepted Spartan students for practical training on patients in surgical and cancer departments, among others.

``I think we need to do something to assure the people of Connecticut that anyone who comes to work in our hospitals is properly educated and accredited,'' Galvin said.

Spartan officials offered no comment for this story.

Galvin, who was recently appointed commissioner of the Department of Public Health, said he expects the hospitals will voluntarily stop accepting Spartan trainees for clinical rotations until a team of qualified investigators can determine whether the school is ``up to snuff.''

Connecticut does not ban hospitals from training students from any schools, nor does it ban graduates of any specific schools from practicing.

Unlike medical residents, who have graduated from medical school and are licensed physicians who work for relatively low pay in exchange for specialized training, students on clinical rotations are generally in their third or fourth year of medical school. They do physicals, take patient histories and perform minor procedures under the supervision of a resident.

William Powanda, a spokesman for Griffin Hospital, said the hospital is reviewing its relationship with Spartan as part of a broader look at Griffin's medical education program.

Powanda stopped short of saying that Griffin had suspended the practice of accepting Spartan students while the review is underway, but said that students from other schools would be given priority for acceptance.

There are no students from Spartan currently at Griffin, he said.

``It's kind of a broad review that's looking at the entire student program and discretely at the relationship with Spartan as well,'' Powanda said. ``While that process is in place, we are choosing to accept students from schools other than Spartan right now.''

Galvin's interest has sparked a similar review at St. Raphael's and St. Mary's, hospital officials said.

Currently, there is no national organization that systematically assesses the quality of foreign medical schools. For licensing purposes, many states, including Connecticut, rely on a directory of international schools published by the World Health Organization in Geneva.

That directory, however, is little more than a listing of medical schools that are recognized by the country in which they are located. Even the authors of the WHO list warn against relying too heavily on their directory for quality assurance, pointing out at the beginning of the guide that they do not formally recognize or accredit the schools.

Some states, such as New York and California, have their own teams of inspectors for off-shore schools. But those states are such desirable destinations for the mostly American students that the schools are generally willing to foot the bill for their own inspections in the hope of gaining approval.

Smaller states don't have that kind of economic clout.

That's why a group like the Federation of State Medical Boards, a trade organization based in Texas that represents state officials who issue medical licenses, would be a logical body to assume the task of inspecting foreign schools, Galvin said.

While FSMB officials acknowledge that a national standard for evaluating foreign medical schools would be valuable, executive director Jim Thompson said his organization is ill-equipped to do the job.

``Accrediting a medical school is not a simple process,'' Thompson said. ``When U.S. schools are accredited, a team of five people descends on them for five days and reviews stacks of documents 24 inches high.''

Thompson acknowledged that five people would start bumping into each other after five minutes during an inspection of Spartan, which consisted of a single building with four classrooms, one lab and three cadavers when The Courant visited last October.

But even the apparent simplicity of inspecting such a small school would create its own set of bureaucratic obstacles.

``In that case, what information would somebody want to have from these schools?'' Thompson asked. ``Are you going to have to lower the standard for international schools?''

Even if no national system for approving international schools is established, the concerns about Spartan and its connections to Connecticut hospitals are such that Galvin would be willing to send his own investigators to St. Lucia to inspect the school.

``I'm of the opinion that somebody should take a close look at this place,'' Galvin said.

Failing that, the health department could insist that all hospitals follow the lead of the UConn Medical Center, which trains students only from schools in North America that have been approved by the American Academy of Medical Colleges.

But smaller hospitals such as St. Mary's and Griffin, which are not part of an established medical school or located in a major city, have a hard time attracting students from U.S. and Canadian medical schools. For them, access to international students is critical to their goals of achieving the prestige, and economic benefits, associated with being a teaching hospital.